To investigate the frequency of imatinib-induced pancreatic complications and determine whether these are survival prognostic factors in patients with gastrointestinal stromal tumor (GIST).
This retrospective multicenter study included patients with histopathologically diagnosed GIST treated with imatinib who underwent computed tomography (CT) within 100 days before (pretreatment CT) and 500 days after (post-treatment CT) imatinib initiation (January 2004-December 2019). Forty-eight patients (63.0±12.1 years, 30 men) were included. Two blinded radiologists independently measured pancreatic volumes. Pancreatic volume on pretreatment CT was compared with that of the control (within 1 year prior to pretreatment CT) and the first two post-treatment CTs using paired t-tests. Thresholds for pancreatic hypertrophy and atrophy were defined using a log-rank test. The prognostic importance of pancreatic hypertrophy was further analyzed using multivariate Cox proportional hazard regression models.
Pancreatic volume was significantly higher for the first post-treatment CT than pretreatment CT (71.5cmvs. 67.4cm, P=.027), whereas no significant difference was observed between the pretreatment and control CTs. Optimal thresholds for pancreatic hypertrophy and atrophy were defined as an 22% increase and 30% decrease and found in 20 and three patients, respectively. Pancreatic hypertrophy was significantly associated with reduced survival [hazard ratio=2.9 (95% confidence interval, 1.3-6.5), P=.0088]. No patients showed serum lipase elevation, nor were they suspected of having acute pancreatitis.
There was frequent asymptomatic pancreatic swelling in patients with GIST after imatinib treatment, and a ?22% increase in pancreatic volume was a predictor of reduced survival.
There was frequent asymptomatic pancreatic swelling in patients with GIST after imatinib treatment, and a ?22% increase in pancreatic volume was a predictor of reduced survival.Pancreatic neuroendocrine neoplasms (PNENs) show heterogeneous biological behavior, and most small PNENs show indolent features. Consequently, selected cases can be considered for observation only, according to the National Comprehensive Cancer Network guideline, however, supporting clinical evidence is lacking. We investigated the clinical course of small PNENs and their risk factors for malignant potential.
A total of 158 patients with small pathologically confirmed PNENs ?2cm in initial imaging were retrospectively enrolled from 14 institutions. The primary outcome was any metastasis or recurrence event during follow-up.
The median age was 57 years (range, 22-82 years), and 86 patients (54%) were female. The median tumor size at initial diagnosis was 13mm (range, 7-20mm). PNENs were pathologically confirmed by surgery in 137 patients and by EUS-guided fine needle aspiration biopsy (EUS-FNAB) in 21 patients. Eight patients underwent EUS-FNAB followed by surgical resection. The results of WHO grade were available in 150 patients, and revealed 123 grade 1, 25 grade 2, and 2 neuroendocrine carcinomas. A total of 145 patients (92%) underwent surgical resection, and three patients had regional lymph node metastasis. During the entire follow-up of median 45.6 months, 11 metastases or recurrences (7%) occurred. WHO grade 2 (HR 13.97, 95% CI 2.60-75.03, p=0.002) was the only predictive factor for malignant potential in multivariable analysis.
WHO grade is responsible for the malignant potential of small PNENs ?2cm. https://www.selleckchem.com/products/mk-8719.html Thus, EUS-FNAB could be recommended in order to provide early treatment strategies of small PNENs.
WHO grade is responsible for the malignant potential of small PNENs ?2 cm. Thus, EUS-FNAB could be recommended in order to provide early treatment strategies of small PNENs.Sleeve gastrectomy (SG) recently became the most frequently performed bariatric surgery (BS) worldwide, overtaking the long-time standard Roux-en-Y gastric bypass (RYGB). Main indications for one or the other procedure show large inter-center variations and warrant further investigations.
The aim of this study was to identify the influencers of primary BS selection in Switzerland.
Switzerland.
Retrospective analysis of all hospitalizations in Switzerland January 1, 2011 through December 31, 2017 with anonymized data provided by the Swiss Federal Statistical Office. BS procedures were identified based on ICD-10 and national surgical codes. Statistical analyses were performed with R.
During the study period 27,375 BS were performed. The annual BS caseload doubled over time, whereas inpatient complications decreased (?-33%). RYGB was the prevailing procedure, although its annual proportion decreased from 80% to 70% over 7 years. Meanwhile, use of SG increased from 14% to 23%. Primary RYGB and SG had sion making.We asked a group of four researchers without experience in the field, to fill in the simplified Scoring Table based on Conversational Analysis principles. Researchers underwent a single-day training based on the linguistic differences in the event description by patients with epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES). Two raters reached 100% agreement with the gold standard and even in the worst case the error was only 25%. This tool could be used for first screening, because it is very easy to administer, both for the interview and for the Scoring Table completion, confirming the usefulness of Conversation Analysis in differential diagnosis between ES and PNES.Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease.